Bronchial CA Flashcards
Main risk factors of bronchial CA
- Cigarette smoking
- Passive smoking (1.5 times greater)
- Occupation exposure – arsenic, chromium,
iron oxide
Main two types of bronchial CA
- Small cell CA – 3 years, initial malignant
change to presentation - Non-small cell CA – 15 year for Adeno CA, 8
years for squamous CA
Non small cell CA types
Squamous CA
Adeno CA
Large cell CA
Bronchoalveolar CA
Early presentation type of bronchial CA
Small cell CA
Most common Bronchial CA type
Squamous CA
CA seen in almost exclusively in smokers
Squamous cell CA
Central and cavitating type of bronchial CA
Squamous cell CA
Presentation of squamous CA
Obstructive lesion to bronchus presenting as infection
squamous cell CA is well differentiated (T/F?)
True
Local spread is common in Squamous cell CA
True
widespread mets are common in small cell CA
False. It’s rare
AdenoCA is mostly peripherally located
True
Adeno CA arises from mucous cells from the alveolar epithelium
False. mucous cells from the bronchial epithelium
Adeno CA most common invading sites
Invasion to pleura, mediastinal lymph
nodes, metastasis to brain, adrenal gland
and bones
Adeno CA is mostly associated with….
non- smokers and asbestos
what is the less differentiated forms of squamous cell CA and adeno CA
Large cell CA
bronchial CA that presents as diffuse or solitary nodules
Bronchoalveolar CA
Location of small cell CA
Central and apical
SSC arise from…. cells
Endocrine cells aka Kulchitsky cells aka APUD cells
SSC are easily operable at the time of presentation
False. Almost inoperable. early spread
Does SSC respond to chemo and radiotherapy
Yes
Clinical features of Bronchial CA
- Cough
- Chest pain – pleuritic pain
- Haemoptysis
- Malaise
- Weight loss
- Hoarseness of voice
- Signs of pleural effusion, collapse
Sites of direct spread
pleura, ribs
CA apex- lower part of brachial plexus
Hilar tumors- RLN
Phrenic nerve
Superior Vena Cava
Esophagus
Manifestations of direct spread to the CA apex
horner’s syndrome
manifestations of direct spread to the hilum
RLN involvement causes U/L vocal cord paresis, hoarseness, bovine cough
Manifestations of direct spread of bronchial CA to the Superior vena cava
early morning headache,
facial congestion and oedema of upper
limbs
Metastatic complications of bronchial CA
- Bone metastases (pathological fractures)
- Liver involvement
- Brain involvement
- Spinal cord compression
- Adrenal involvement
Sx of Liver involvement of direct spread of bronchial CA
RHC pain
LOA
Icterus is a very late sign
Sx of Brain involvement of direct spread of bronchial CA
early morning headache
vomiting
adult- onset seizures
Non-metastatic extrapulmonary
manifestations is also known as
paraneoplastic syndrome
Paraneoplastic syndrome in bronchial CA
- Finger clubbing
- Hypertrophic pulmonary
oesteoarthropathy - Metabolic – loss of weight, anorexia
- Endocrine – usually small cell CA
o Ectopic ACTH secretion
o SIADH
o Hypercalcaemia – usually squamous cell
CA - Neurological
o Encephalopathies (cerevellar
degeneration)
o MND
o Peripheral sensorimotor neuropathy
o Muscle disorders
o Lambert Eaton syndrome - Vascular
o Thromboplebitismigrans
o DIC
o Haemolytic anaemia - Cutaneous (rare)
o Dermatomyositis
o Acanthosis nigricans
Ix done for Bronchial CA
- CXR
- CECT
- Fiberoptic bronchoscopy
- Percutaneous aspiration and biopsy
Mx of bronchial CA
- Surgery – can be curative in non-small
cell lung cancer - Radiation therapy for cure (Radiation
pneumonitis) - Chemotherapy
- Laser therapy, endobronchial irradiation,
Stents - Palliative treatment
Clubbing DDs
CVS - Cyanotic HD, Atrial myxoma, Inf endocarditis
Respi- Bronchiectasis, Lung Abscess, Bronchial CA
